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Cancer Poses Challenges for Workers Trying to Stay on the Job

Work can be a welcome distraction from illness but also a source of physical, emotional, and financial stress.

Summary

Pursuing a career and dealing with work-related issues can be challenging during cancer treatment and recovery, but there are ways to get help and find the balance.

Money and benefits — including health insurance — are probably the most obvious reasons why we work. But many people also derive a sense of purpose, accomplishment, and satisfaction from their jobs.

Cancer and its treatment can make it more difficult or even impossible to continue working at the same pace as before a diagnosis — or, in some cases, to work at all. And job-related worries can add to the financial and psychological stress of the disease. “For people that work, whether or not they will manage to stay employed while they go through treatment is a huge concern,” says Debra Wolf, an attorney for the New York Legal Assistance Group who works with cancer patients on legal and employment issues.

How much cancer will impact your ability to work depends on the type of cancer, its stage, and its treatment. Likewise, the kind of work you do, whether it’s physical labor, a desk job, or a combination of tasks, is also a factor.

Even if you’re feeling OK, it can still be challenging to keep up with your job responsibilities while making time for doctor’s appointments, tests, and follow-ups, and ensuring you get enough rest to help in your recovery. As much as possible, “give yourself permission to take care of yourself,” says Mary McCabe, director of Memorial Sloan Kettering’s Survivorship Center. That may include scaling back and accepting that you may need to move more slowly for a while.

To help cancer patients deal with their work-related concerns, experts offer the following advice.

Decide When to Tell

Determining when — and even if — you want to share your cancer diagnosis with your co-workers is a highly personal choice. By law, patients do not need to divulge their diagnosis to their employer, says Alan Engelberg, a Memorial Sloan Kettering occupational medicine physician. (You may need to disclose some information about your medical condition if you’re applying for leave or accommodations, though.)

Some may find the support and friendship of co-workers helpful. Others, particularly those who work in a highly competitive or unflexible environment, may find there are negatives to sharing. Freelance, temporary, self-employed, or contract workers may also legitimately worry that disclosing a cancer diagnosis could jeopardize future contracts or assignments.

“There are many employers who are supportive of their employees with cancer. There are so many people that have been touched by cancer — they’ve had friends and family members who have had it,” Ms. Wolf says. “But there are circumstances in which discrimination does exist.”

Another consideration is how you’ll handle co-workers’ reactions. Some people may surprise you with their caring and empathy; others may ask intrusive questions or make unhelpful comments. It may help to consider beforehand how you’ll answer and how much you’re willing to disclose.

Explore Your Options

Whether you continue to work, whether you want to continue to work, and to what extent you need to work are also highly individual. Maintaining income and health insurance are of course big reasons cancer patients have for staying on the job. But many carry on working because they feel well enough to do so, appreciate the routine of their job, and value the distraction from thinking about their health.

“Maintaining normalcy is a positive thing. It reminds people they can still do some of the things that are important to them,” Ms. McCabe says. “But work can be a source of stress, too, if people aren’t feeling well or if they’re worried about performance.”

To make it possible to stay on the job, you may be able to seek accommodations such as shortened workdays or workweeks, extra breaks, later start times, working from home some days, or temporarily swapping certain job responsibilities with a co-worker, Dr. Engelberg says.

Enlist Your Treatment Team

Discussing your job and financial concerns with your clinical team is a good starting point, Ms. Wolf says. They can give you an idea of what to expect from the treatment and can advise you whether it’s safe and realistic for you to stay on the job, she adds.

If you’re seeking job accommodations, ask your physician to write a note giving specifics about the tasks you can perform, if there are certain things you can or cannot do, and for how long you will need accommodations. These details can help your employer or human resources department figure out how to assist you, Dr. Engelberg says.

Know Your Rights

Before you meet with human resources or your supervisor, familiarize yourself with your company’s policies and with certain key federal and state laws that offer some job protection to people with cancer.

The 2008 amendment to the Americans with Disabilities Act (ADA) requires employers to make certain accommodations for cancer patients. However, there are limits to what employers have to do, and the ADA does not protect you from losing your job if you are unable to perform its essential functions. The US Equal Employment Opportunity Commission has additional info on cancer and the ADA.

The ADA applies to employers with more than 15 employees; New York State has a law that extends similar protections to employers with four or more employees.

The Family and Medical Leave Act (FMLA) is a federal law that lets employees of large and medium-size employers take up to 12 weeks of unpaid time off, either all at once or in increments, due to an illness or a family member’s illness. (For more information, visit the US Department of Labor.)

A major concern for many cancer patients is maintaining their health insurance. Employees who leave a job are able to maintain their benefits for 18 months or longer under COBRA. But that can be expensive, since former employees have to pay both their portion and their employer’s portion of the premium.

As a result of the Affordable Care Act, cancer patients now have other options, Ms. Wolf says, including purchasing coverage via the healthcare exchanges or possibly qualifying for Medicaid coverage. (For more information, visit HealthCare.gov.)

Seek Help

Trying to decipher your company policies or employment law may be the last thing you feel like worrying about while dealing with cancer and cancer treatment. If you need help, there are several excellent online resources, including AskJAN and Cancer and Careers. You can also consider reaching out to an attorney who is familiar with cancer-related issues in the workplace, Wolf says.

Another upcoming event for people in the New York City area is the National Conference on Work & Cancer, hosted by Cancer and Careers, to be held June 13 at the Graduate Center at the City University of New York. Registration is free.

Julie, we received some additional suggestions from Debra Wolf, the attorney who was interviewed for this post. She recommends you contact an attorney who specializes in providing free legal services to people with cancer, like she does. Most states have some resources to provide advice. You may be able to search for attorneys in your area through this national cancer legal service network: http://www.nclsn.org. Often the EEOC is helpful as well: http://www.eeoc.gov/contact/

Chris

Jun 2, 2014 • 1:26 PM

I drive a gravel truck for the district before chemo treatments, after 3 weeks on a rtw I was ready for full-time work, than the employer wanted me to switch trucks and drive the Asphalt truck, I requested not to becuase of the fumes, the employer told me if I refused to drive the Asphalt truck I would be disciplined or not paid, I drove the Asphalt truck and became ill, the employer said that maybe I can't drive any of the trucks, I only had issues with the Asphalt truck, not the gravel trucks, I've been put back on LTD, do I have any rights?
Thanks in advance, Chris

Chris, we received some additional suggestions from Debra Wolf, the attorney who was interviewed for this post. She recommends you contact an attorney who specializes in providing free legal services to people with cancer, like she does. Most states have some resources to provide advice. You may be able to search for attorneys in your area through this national cancer legal service network: http://www.nclsn.org. Often the EEOC is helpful as well: http://www.eeoc.gov/contact/

Rosario

Jun 2, 2014 • 8:38 PM

Why are there no answers to the questions above??? Does MSKCC monitor the page to address the questions? Or, does MSKCC feel they have provided a complete service merely by raising the question, and providing a macro question? What is the advocacy role of MSKCC? How does MSKCC help with the emotional and non-medical pain of negotiating work and life as a cancer patient. I hear pain and anguish in the questions and scenarios described by Julie and Chris. ~~They are both in my prayers, as I, too, must balance cancer treatment with the need to work.

Dear Rosario, we do monitor our blog regularly and do our best to respond to questions as soon as possible. We are still looking into answers for the questions we received today.

To address your question about emotional and non-medical concerns, we offer a number of resources and support services, including counseling, support groups (in-person and online), online forums, and countless other programs. If there is something in particular you're looking for, please do let us know. And if you are in NYC, we hope you are able to attend a talk we are hosting tomorrow evening on the subject of cancer and legal issues, particularly those related to work.

Having worked as a public information officer for a comprehensive cancer center (and now that I am a patient), I can say that it's not always possible to respond quickly to questions posed. Though electronic communication makes it seem as though "instant answers" should be possible, some inquiries take longer to research. I've also learned that sometimes what appears to be the "question" isn't necessarily what is on someone's mind. It's appreciated that MS-KCC takes the time to respond thoughtfully to all questions asked.